Investigator
Unknown Institution
Cervical Cancer 2010–2019: An Upper Midwest Catchment of 40,000 Square Miles
Objectives American Indian (AI) women have a higher incidence and mortality from cervical cancer than non-Hispanic White (NHW) women in the US. This article’s purpose is to detail the clinical events in the cervical cancer prevention continuum among the AI and White women with cervical cancer on the US frontier. Materials and Methods A cancer center with a nearly 40,000 square-mile catchment area maintained a detailed cancer registry connected to the clinic records of all cervical cancer patients between 2010–2019. This catchment area provided records of both an AI and a White population. Descriptive and inferential statistics and modeling predictions detailed the prevention continuum. Results Among the 126 with cervical cancer, 20% were AI, and 78% were White. Sixty percent did not participate in cervical cancer screening within the 5 years before their diagnosis, and on average, 9.2 years passed since the last cervical cancer screening. 91% presented with symptoms, and most women presented with 2 or more symptoms. Thirteen percent underwent a colposcopic diagnostic step, significantly delaying the time to diagnosis compared to other diagnostic steps. Sixty-nine percent of the histopathologic diagnoses were squamous cell carcinoma, and 27% were adenocarcinoma. Forty-nine percent presented at stage I regardless of histopathology. Chemotherapy and radiation therapy were most commonly combined. Sixty-three percent of the population survived, and 42% survived at least 3 years from diagnosis. Younger age and earlier stages at diagnosis were the significant adjusted predictors of survival. Conclusions The authors’ detailed cervical cancer prevention continuum events provide new data questioning the use of colposcopy for women symptomatic at presentation.
The impact of a positive COVID-19 test on timeliness of radiation in patients receiving brachytherapy
Delays in initiating and completing brachytherapy may have adverse oncologic outcomes for patients with cervical, uterine, and prostate cancer. The impact of the COVID-19 pandemic on brachytherapy in the United States has not been well-characterized. We aim to evaluate how a positive COVID-19 test affected timeliness of treatment for patients undergoing brachytherapy for cervical, uterine, and prostate cancer. We queried the National Cancer Database to identify patients diagnosed with cervical, uterine, and prostate cancer in 2019 and 2020 who received brachytherapy in their treatment. Patients who tested positive for COVID-19 between cancer diagnosis and start of radiation were compared to those who did not test positive for COVID-19. Time in days from cancer diagnosis to initiation of radiation was compared using two-sample t-tests with p < 0.05 signifying significant differences. We identified 38,341 patients with cervical (n = 6,925), uterine (n = 18,587), and prostate cancer (n = 12,829). Rates of COVID-19 positivity were cervical cancer (n = 135; 2%), uterine cancer (n = 236; 1.3%), and prostate cancer (n = 141; 1%). Of those, 35% of cervical, 49% of uterine, and 43% of prostate cancer patients tested positive between their cancer diagnosis and initiation of radiation. Median days to radiation was significantly longer in these patients: 78 versus 51 for cervical cancer (p < 0.01), 150 versus 104 for uterine cancer (p < 0.01), and 154 versus 124 for prostate cancer (p < 0.01). For patients with cervical, uterine, and prostate cancer diagnosed between 2019-2020, testing positive for COVID-19 after their cancer diagnosis was associated with a delay to initiation of radiation by 4-7 weeks.
Native American Women's Willingness to Screen for Both Cervical and Colorectal Cancer at Home
ABSTRACT Introduction Fewer than 50% of Native American (NA) women screen for both cervical and colorectal (CRC) cancer. We aim to explore the perspectives of NAs around cervical and colorectal cancer home‐based self‐screening options. Methods The NA community provided review and approval for this cross‐sectional survey on cancers in general, and specifically on cervical and colorectal cancer screening. We invited screen‐eligible Native American women, aged 45–65 years, who attended the Lakota Nation Invitational tournament in December 2023, to complete the survey. Results One hundred women, with a mean age of 54.1 (SD 6.3), completed the survey. Respondents reported visiting their doctor once a year, rarely (10%), with 66% experiencing a poor experience accessing healthcare—only 16% self‐reported screening for both cervical and colorectal cancers within the last 5 years. If the participant could screen for both cervical and CRC cancer at home, 83.0% said they would be willing to do both, compared to 9% who would do neither at home. The doctor's recommendation for how to screen for cervical and CRC cancer was the most important factor in screening decision‐making. The other two very important reasons were how easy or convenient the screening is, how comfortable I am with the screening process/what happens to me during the test. Conclusions With the recommendation of their doctors, and convenience and comfort being important, Native American women are enthusiastic to participate in home‐based cervical and colorectal cancer screening. While the home‐based CRC screening has been available for many years, with minimal effect on screening uptake, the advent of self‐sampling for primary HPV testing for cervical cancer appears to create interest for both tests at home. These options may increase both cancer screening rates and access to care in this underserved population.
